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Bae, Kwon, Kim, Yoon, Lee, Lee, Kim, Min, Cha, Chae, and Hwang: Survey Results of Medical Insurance Reimbursement System for Independent Medical Laboratories in Korea
Original Article

Korean J Leg Med 2007;27(2):143-150.

Published online: 10 February 2007

DOI: https://doi.org/10.3343/kjlm.2007.27.2.143

Survey Results of Medical Insurance Reimbursement System for Independent Medical Laboratories in Korea

Sook Young Bae, M.D.1, Jung-Ah Kwon, M.D.1, Jang Su Kim, M.D.1, Soo-Young Yoon, M.D.1, Chang Kyu Lee, M.D.1, Kap No Lee, M.D.1, Dae-Won Kim, M.D.2, Won Ki Min, M.D.3, Young-Joo Cha, M.D.4, Seok Lae Chae, M.D.5, Yoo-Sung Hwang, M.D.6

1Department of Laboratory Medicine, College of Medicine, Korea University, Seoul, Korea

2Department of Laboratory Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea

3Department of Laboratory Medicine, University of Ulsan and Asan Medical Center, Seoul, Korea

4Department of Laboratory Medicine, College of Medicine, Chung-Ang University, Seoul, Korea

5Department of Laboratory Medicine, College of Medicine, Dong Guk University, Kyungki Province, Seoul, Korea

6Department of Laboratory Medicine, Neodin Medical Laboratory, Seoul, Korea

Received 19 June 2006       Revised 4 January 2007       Accepted 4 January 2007

Copyright © 2007 The Korean Society for Legal Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

A questionnaire survey was performed to perceive the problem of the current medical insurance reimbursement system for laboratory tests referred to independent medical laboratories; then, we intended to find a way to improve the reimbursement system.

Methods

Questionnaires were distributed to 220 independent medical laboratories and 700 laboratory physicians from July through October 2005. Frequency analysis was used to analyse the replies from 109 respondents to 25 questionnaire items regarding the current medical insurance reimbursement system for referral tests, problems with the system, and suggestions for the improvement of the system.

Results

Among the 109 respondents to this survey, 49 (45.8%) considered the current reimbursement system to be unsatisfactory, while only 16 (15.0%) answered satisfactory. The problem was that the referral clinics-not the laboratories that performed the tests–would first receive their reimbursement for the laboratory tests from Health Insurance Review Agency (HIRA) and then give a portion of the laboratory test fees to the independent medical laboratories after the deduction of administrative fees. They (62.5% of the respondents) would prefer a separated reimbursement system by which the referral clinic-as well as the independent medical laboratory-would receive their reimbursement directly from HIRA through an Electronic Data Interchange (EDI) system. In this new system, 34% of the respondents expected the quality of the laboratory tests to be improved; however, 41.6% answered that the income of the referral clinic is expected to decrease.

Conclusions

For the improvement of the medical insurance reimbursement system, the administrative fee for the referral clinic and the test fee for the independent medical laboratory should be reimbursed directly to the respective organizations. These changes could be made possible with the proper analysis of medical costs and the development of an effective EDI reimbursement system.

Keywords: Medical insurance reimbursement system, Survey, Medical costs, Electronic data interchange system

References

1. Henry JB, Kurec AS. The clinical laboratory: organization, purposes, and practice. Henry JB, editor. Clinical diagnosis and management by laboratory methods. 20th ed.Philadelphia: WB Saunders;2001. p. 3–7.
2. Travers ED, McClatchey KD. Basic laboratory management. MaClatchey KD, editor. Clinical laboratory medicine. 2nd ed.Philadelphia: Lippincott Williams & Wilkins;2002. p. 3–4.
3. Suh IB, Ma KR, Lee SM, Kwon JA, Bae SY, Yoon SY, et al. Management of clinical laboratory staffs in Korea (II). J Clin Pathol Qual Control. 2002; 24:237–42.
4. Mori M. Activity of clinical laboratory physicians in national health insurance. Rinsho Byori. 2005; 53:1030–5.
5. Korean Hospital Association. Standard for reference of laboratory test. 2005 Health insurance reimbursement. Jan ed. 2005; 439–44.
6. Cha YJ. Analysis of medical insurance costs. Korean J Lab Med. 2005; 25:106–12.
7. Medical Service Act: Section 12. Protection for medical technology. 2006.

Fig. 1.
Degree of priority and agreement according to the problem of reimbursement process of referral test.
kjlm-27-143f1.tif
Table 1.
Characteristics of laboratory physicians* who responded
  Number of results† (%)
Sex  
Male 27 (43.5)
Female 35 (56.5)
Total 62 (100)
Years of board certification  
Over 20 yr 10 (21.7)
10–19 yr 15 (32.6)
Less than 10 yr 21 (45.7)
Total 46 (100)
Hospitals and institutes  
Clinics 1 (1.6)
Small hospitals (<200 beds) 1 (1.6)
Large hospitals (>200 beds) 20 (32.3)
University hospitals 36 (58.1)
Independent medical laboratories 3 (4.8)
Blood service centers 1 (1.6)
Total 62 (100)

* Laboratory physician denotes a member of the Korean Society for Laboratory Medicine.

† Unanswered items of questionnaire are included.

Table 2.
Levels of satisfaction at the current insurance reimbursement system
Responders to questionnaires Number of cases (N) Satisfaction levels (%)
Very dissatisfied Dissatisfied Mean Satisfied Very satisfied
Independent medical laboratory* 44 12 (27.3) 6 (13.6) 14 (31.8) 10 (22.7) 2 (4.5)
Laboratory physician† 63 5 (7.9) 26 (41.4) 28 (44.4) 4 (6.3) 0 (0.0)
Total 107 17 (15.9) 32 (29.9) 42 (39.3) 14 (13.1) 2 (1.9)

* Independent medical laboratory denotes the laboratories solely devoted to the tests referred by hospitals and institutes.

† Laboratory physician denotes a member of the Korean Society for Laboratory Medicine.

Table 3.
Reasons for dissatisfaction at the current payment system
Reason Number of responders (%)
Independent medical laboratory* Laboratory physician† Total
Laboratory test fee not received directly from HIRA 5 (26.3) 21 (50.0) 26 (42.6)
Referral clinics' demand for test price discount 8 (42.1) 14 (33.3) 22 (36.1)
Difficult to receive laboratory test fee 2 (10.5) 4 (9.5) 6 (9.8)
Other 4 (21.1) 3 (7.1) 7 (11.5)
Total 19 42 61 (100)

* Independent medical laboratory denotes the laboratories solely devoted to the tests referred by hospitals and institutes.

† Laboratory physician denotes a member of the Korean Society for Laboratory Medicine. Abbreviation: HIRA, Health Insurance Review Agency.

Table 4.
Proposed improvement plans for the insurance reimbursement system
Responders to questionnaires Number of responders All fees reimbursed to RC Reimbursed to RC and IML respectively Reimburse request respectively and all fee is received by RC Reimburse request respectively and all fee is received by IML The others
Independent medical laboratory 41 14 (34.1) 21 (51.2) 0 (0.0) 4 (9.8) 2 (4.9)
Laboratory physician 63 9 (14.3) 44 (69.8) 4 (6.3) 6 (9.5) 0 (0.0)
Total 104 23 (22.1) 65 (62.5) 4 (3.8) 10 (9.6) 2 (1.9)

Abbreviations: RC, referral clinic for laboratory test; IML, independent medical laboratory. Please refer Table 2 or 3.

Table 5.
Effects of the improvement of reimbursement process
Questionnaire items Number of responders (%)*
Prohibition of test price adjustment 42 (46.2)
Decrease in competition among IML for test fee 25 (27.5)
Easier to receive laboratory test fee 23 (25.3)
Improvement of laboratory test quality 22 (24.2)
Convenience of operation process 15 (16.5)
Other 19 (20.9)

* Double-choice results.

Abbreviation: IML, independent medical laboratory. Please refer to Table 2 or 3.

Table 6.
Expected problems with an improved reimbursement system
Questionnaire items Number of responders (%)*
Difficulty of accounting for a cut in insurance reimbursement 48 (53.9)
Resistance of referral clinic for direct request of an independent medical laboratory 35 (39.3)
Difficulty of dealing with self-payments by patients 21 (23.6)
Difficulty with billing process 21 (23.6)
Difficulty of getting patient information 11 (12.4)
Other 12 (13.5)

* Double-choice results.

Table 7.
Organizational problems expected to occur when the system is changed to allow separate requests for and receipt of insurance reimbursement
Responders to questionnaires Number of responders (%)*
Referral clinic Independent medical laboratory HIRA* Nowhere
Independent medical laboratory* 19 (47.5) 10 (25.0) 3 (7.5) 8 (20.0)
Laboratory physician† 43 (69.4) 7 (11.3) 3 (4.8) 9 (14.5)
Total 62 (60.8) 17 (16.7) 6 (5.9) 17 (16.7)

* Independent medical laboratory denotes the laboratories solely devoted to the tests referred by hospitals and institutes.

† Laboratory physician denotes a member of the Korean Society for Laboratory Medicine. Abbreviation: HIRA, Health Insurance Review Agency.

Abbreviation: HIRA, Health Insurance Review Agency.

Table 8.
Plan of investment when the income of the independent medical laboratory increases
Questionnaire items Number of responders (%)*
Improvement for the quality control and accuracy of laboratory tests 23 (46)
Increase in the employment of laboratory workers 14 (28)
Improvement for the service to client 9 (18)
Investment for facility 5 (10)
Increase in the number of test items 3 (6)
Improvement of turn around time 3 (6)
Fee adjustment of special laboratory tests 3 (6)
Increase in transparency of trade 2 (4)
Setting up a department for quality control 1 (2)
Adjustment of laboratory clerical fee 1 (2)
Development of new technologies 1 (2)

* Subjective question results.

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